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RVM 02-09-22

This document provides details on the surgical technique for myocardial revascularization (RMV). RMV, also known as coronary artery bypass grafting (CABG), is a procedure used to treat coronary artery disease by bypassing blocked sections of arteries using veins from the leg or arteries from other parts of the body. The summary describes the key steps of the RMV surgical process and lists the instruments and devices used at each step, including performing saphenous vein graft harvest, opening the chest cavity, graft fixation and anastomoses, checking graft patency, closure of incisions, and post-operative wound care.

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63 views8 pages

RVM 02-09-22

This document provides details on the surgical technique for myocardial revascularization (RMV). RMV, also known as coronary artery bypass grafting (CABG), is a procedure used to treat coronary artery disease by bypassing blocked sections of arteries using veins from the leg or arteries from other parts of the body. The summary describes the key steps of the RMV surgical process and lists the instruments and devices used at each step, including performing saphenous vein graft harvest, opening the chest cavity, graft fixation and anastomoses, checking graft patency, closure of incisions, and post-operative wound care.

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api-626421480
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© © All Rights Reserved
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02 september,2022

REVASCULARIZATION OF
THE MYOCARDIUM (RMV)
WHAT IS MYOCARDIAL
REVASCULARIZATION?
• It is a surgical intervention that uses veins of the leg,
orarteries from another part of the body, to divert
blood back toobstruction of the coronary arteries,
which are the ones thatsupply oxygenated blood to
the heart.

• • The mission of coronary artery bypass surgery (in


English,Coronary Artery Bypass Grafting, CABG) is to
supply blood tothe areas of the heart that suffer
most from lack of irrigation such asconsequence of
the appearance and growth of lesionscoronary.
WHY IS THIS SURGERY INDICATED?
• Deposits form in people with coronary
artery disease.of cholesterol and fats,
called plaques (lesions), in thecoronary
arteries. This process is called
atherosclerosis.(hardening of the arteries)
and is progressive. if it followsdepositing
material in plaque, the coronary arteries
canpartially or completely obstructed
and, consequently, theheart may not
receive enough oxygen carried by
theblood. If this happens, it can lead to
angina pectoris or,even a myocardial
infarction.
ORGANIZATION STAGE
• 1. Opening of the Cardiovascular Disposable Package. (open technique).
• 2. Check indicators.
• 3. Carry out the circulation of Equipment and Devices to be used in the procedure.
• 4. Perform surgical scrub, dressed, gloved technique closed.
• 5. Organization of the May and Reserve tables.
• 6. Verify that the patient has had a good lavage.
• 7. Dress the patient.
• 8. Location of Mayo and Reserve tables.
• 9. Location of cables and connections: Electrosurgical unit, Suction rubber.
• 10.Dressed as a Surgeon and Assistant.
• 11. Carry out a count of: Compresses and gauze.
MAY TABLE ARRANGEMENT AND
RESERVATION
SURGERY
SURGICAL TECHNIQUE
SURGICAL PROCESS INSTRUMENTS AND DEVICES
1. Perform Saphenous Vein Graft Harvestof the left leg and 1. Scalpel handle #3 blade 15, electrosurgery,
closure of theleaks and permeabilization.An incision is made scissorsmetzembaum, weitlaner separator, clips 200.clammp
for a sternotomy. bull dog , precut silk 4/0, polypropylene2/0, monocrylic 3/0.
2. Incise the pericardium, hemostasis and fixation of 2. Scalpel Handle #7, Blade 15. Electrocautery,Farebeuf
thepericardium for complete visualization of the retractor, dissection forceps without claw.Reciprocating saw.
heart,especially the ascending aorta, placement of .Electroscalpel, dissection forcepsvascular, Silk 0 with needle,
theFinochietto or sternal autostatic retractor. Mayo Scissors. Separatorautostatic Finochietto.
3.Perform the extraction of the internal mammary 3.Breast separator, clips 100, electrosurgical unit,
artery andleave repaired cannulafrazier with CO2 rubber.
4.Perform the stitches for the purse string in the aorta, 4. Polyester 2/0, vascular needle holder,
insuperior and inferior vena cava, superior pulmonary dissectionvascular, mayonnaise, curved Kelly clamp,
veinright for the placement of the grommet tourniquetsand pass threads.
turnstilesand it is repaired.
5. Perform arteriotomy and venotomy, to 5. Scalpel handle 7 # 15, vascular dissection
performsubsequently cannulation with each of forceps,pre-cut silk 0, venous catheter, arterial
thecorresponding cannulas. and fix the cannulas. catheter,left line catheter, mayo scissors.
6. The connection of the circuit tubes is 6. Extracorporeal circuit tubes passed to us by
madeextracorporeal, in order to start the theperfucian.
circulationextracorporeal
SURGICAL PROCESS INSTRUMENTS AND DEVICES

7.Start saphenous vein graft fixationfirst anastomosis in 7. Poliester 2/0 con ptfe Tijera de mayo ,Portaaguajas,
descending arteryback and placement of straight stitches. polipropileno 7/0 , pinza disección fina , cánula de frazier , caucho
de CO2.polipropileno 6/0 11 . Mango bisturí 15 , pinza disección
vascular 12 Hilo marcapasos y pleurovac. 14 Alambre quirúrgico #5
, poliglactina 910 0, monocryl 3/0 portaagujas . 15 . Compresa
húmeda , apósito de plata , apósito grande .
8.Mobilization of the heart from the apex tosaphenous
vein graft fixation and anastomosiswith circumflex
artery.Anastomosis of the internal mammary artery with
theanterior descending artery.
9. Check the patency of the anastomoses.
10. Aortic closure, remove the aortic clampfor pump outlet
11 Withdrawal of cardiovascular cannulae. 11. Scalpel handle 15, vascular dissection forceps
12. Placement of the pacemaker wire and chest tube. 12 Pacing wire and pleurovac.
13 Hemostasis and pad count andgauze.
14 Perform sternal and muscle and skin closure. 14 #5 Surgical Wire, Polyglactin 910 0,monocryl 3/0
needle holder.
15 Wound cleansing and healing 15. wet compress, silver dressing,large dressing.

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